Provider Demographics
NPI:1912146176
Name:HURTT, HEATHER FRASER (MS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:FRASER
Last Name:HURTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 PROFESSIONAL DR STE 100G
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7781
Mailing Address - Country:US
Mailing Address - Phone:916-782-6654
Mailing Address - Fax:916-781-6974
Practice Address - Street 1:2330 PROFESSIONAL DR STE 100G
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7781
Practice Address - Country:US
Practice Address - Phone:916-782-6654
Practice Address - Fax:916-781-6974
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist